Artistic License  Pharmacology

aka: You Fail Pharmacology Forever

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Ah, the wonderful world of medications, drugs, and poisons. Staples of Murder Mysteries and Medical Dramas, and not too infrequently plot devices in Science Fiction (hard or otherwise). Sadly though, there are some writers who never seem to do their homework on the substances in question. Books, screenplays, etc. from such writers often cause those knowledgable of such things to want to ask, "Dude, what have you been smoking?" The absolute worst examples may lead to beingKilled Off for Real.

The following examples do not fit any subtropes:

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Anime And Manga

Death Note features a criminal who, according to his bio, is extremely violent and deranged because he is a marijuana addict. Marijuana's effects do not include violent criminal behavior. This could be due to Marijuana Is LSD, or because marijuana use is highly stigmatized in Japan, to the point where Paul McCartney wasn't allowed into the country for ten years following a pot bust.

In the English dub of Digimon Adventure, Tai and Izzy search Machinedramon's city for aspirin after Kari develops a fever during the Dark Masters arc. In reality, most pharmacists recommend avoiding the use of aspirin in children under twelve, particularly for controlling viral symptoms, as this can increase the child's risk of developing a serious condition called Reye's syndrome; acetaminophen or ibuprofen would have been safer choices for Kari.

One Nobunaga no Chef arc involves Kennyo trying to poison Nobunaga by serving him several nutmeg macarons. Nobunaga almost immediately collapsed after eating them, despite the fact that: 1) The amount of nutmegs placed in 3 macarons are nowhere near enough to cause poisoning, 2) Fatal nutmeg poisoning is very rare, 3) Nutmeg intoxication takes a few hours after consumption to reach its effects.

Comic Books

Every comic-book use of drugs fails miserably at pharmacology, especially the Batman villain Scarecrow, since his gimmick is a hallucinatory "fear gas." Hallucinogens take 30-90 minutes to circulate to the brain and actually cause hallucinations (and almost all are administered orally). Hallucinations are also extremely unpredictable and are usually caused by setting and expectations before ingesting the drug and most people can easily tell a hallucination from reality, although the Scarecrow does supply some set up by naming it a fear gas. In short, the drug onset is unlikely, the route of administration is atypical, and most importantly, the effects are wrong. Some drugs might fit:

If you think the effects of salvia are not capable of inducing fear to the degree that it could be used as a weapon, you've obviously never smoked it. "Rapid onset" means just a few seconds, a minute at most. The reason it hasn't caught on as a party drug is that large doses (which are actually still very small) can cause the person to experience horrifying hallucinations.

It also causes a very short period of sharp decrease in muscle tonus which is usually reported as disconcerting. It may be also pretty surprising for anyone truing to smoke salvia while standing. And hallucinations usually occurs in massive dosages in already phobic or anxious subjects. Hallucinations are endogenous, so it is technically impossible to create a drug that will predictably cause a repeatable horrifying hallucination in every recipient.

DMT, without an MAO inhibitor, can be smoked - nearly instant onset, incredibly strong effects. Without an MAO inhibitor, it only lasts ten minutes, with one it lasts much longer. See also 'datura' also called devil's weed or jimsonweed, which is notorious for its 'true' hallucinations, often indistinguishable for reality.

An important thing to remember about onset time is that it's vastly dependent on route of administration, orally ingested drugs take a longer time to work because they have to be absorbed through the stomach lining and it takes awhile for them to filter into the bloodstream, inhalation is much faster as the drug goes directly from the lungs into the blood stream, most smoked or inhaled drugs will start to show effects within a few minutes possibly even a few seconds, with peak effects kicking in within 5-20 minutes.

The Marvel Comics one-shot title "Carnage: Mind Bomb" shows the side effects to a vitamin c overdose as being a severe shock to the nervous system. Dr. Kurtz, after blasting Carnage with a sonic pistol to keep him at bay, injects Cletus Kasady with an overdose of vitamin c which causes the symbiote to disconnect from Kasady's brain and body. At best, Cletus would suffer indigestion if it had been taken orally but by injection any excess would be filtered out with no such side effects. This sort of happens as the vitamin c is metabolized out quickly(in minutes, but the writers had the good sense to tell us that his metabolism was much higher than normal so it didn't seem too much like magic or convenience) and the symbiote reconnects. This use of vitamin c is just odd, considering that Dr. Kurtz also injects him with "classified" drugs as well to make Carnage more talkative and open, so why not do the same with the first injection?

Film

Amazingly mostly averted in Crank. Although medical professionals do not agree on how long someone could live without adrenaline, all agree that the symptoms are spot-on and the time frame is not that unrealistic. The description of what the Beijing Cocktail did and what he can do to circumvent its effects is also 100% accurate pharmacology.

In one scene of Meet the Parents, Greg's anxiety becomes so severe he has to treat it by stuffing multiple pieces of nicotine gum in his mouth like a chipmunk and chewing it. Nicotine gum is not supposed to be chewed, but instead placed between the gums and the cheek so that the nicotine can be absorbed through the mucosal membranes over a longer period of time. Chewing the gum causes all of the nicotine to be released at once, possibly leading to an overdose which, though not necessarily fatal, can manifest as a number of different symptoms that will make the user very uncomfortable to say the least.

Played with in Casino Royale (2006). This trope seemingly is played straight with the scene where Le Chiffre's girlfriend slips the poison in Bond's drink. The substance he is poisoned with, digitalis, generally takes several hours to manifest by which point the salt and water emesis which Bond attempts would have been ineffective. It continues to be played straight as Bond is in tachycardia with a heart rate of 135 BPM; digitalis poisoning generally causes bradycardia, or slowing of heart rate. However the trope is played with and averted in the end, as severe digitalis toxicity can in fact produce tachycardia.

Literature

More than one classic mystery fiction writer assumed that aspirin was not just a pain reliever but a sedative as well. Ngaio Marsh was especially prone to having characters take aspirin as an insomnia remedy. In one novel, it was even used as a knockout drug.

To a certain degree, Truth in Television. Many people treat aspirin as if it's a sedative, and if you have a headache or a backache, relieving the pain will help you get to sleep. The placebo effect works particularly well on problems like insomnia.

Poisoned weapons in media are sometimes used to instantly kill an enemy of superior skill if the user even gets a scratch in.

Used in Hamlet, where it was intended to kill no matter who 'won' (and be slow enough that the poisoner would not be suspected in this case).

Averted in A Song of Ice and Fire. The poison that Oberyn Martell uses to kill Gregor Clegane takes weeks or months to kill him. This aversion is itself subverted in that the poison he used should have been fatal in minutes, as soon as it reached his heart, but it was "thickened" somehow to prolong the suffering.

Snow used assassination by poison to rise to power in The Hunger Games. Apparently the Capitol can neither perform autopsies nor test surfaces for presence of toxins.note Can't or won't? In Mockingjay, Katniss describes morphling as making her feel numb and empty. For opiate addicts (who've begun to grow 'immune' to the effects) this may be the case, but morphine makes non-addicts feel relaxed, warm and happy, even through emotional depression.

Live Action TV

Arrow: It starts becoming a bit of a plot point for a couple of episodes that Laurel is guiltily taking pills every so often from a bottle clearly labelled "Benzodiazepine", and eventually gets caught by the police, where it's found she stole those pills from her father and has tested positive for opiates. However, the first problem is that "Benzodiazepine" refers to a group of drugs rather than one particular drug, and the second problem is that benzodiazepines are sedative drugs used for anxiety and insomnia (Valium and Ativan are two common benzodiazepines), they are most certainly not opiates, nor are they anything like them apart from being potentially highly addictive.

Chuck: Likes poisons. One particular example had an enemy spy inject herself with a large quantity of ricin to avoid capture, because "everyone talks". She dies instantly, despite the fact that ricin can take days to work, slowly shutting down its victim's organs and rendering them in a position of considerable pain. Just tell yourself that the large syringe had hit a major blood vessel and she died of internal bleeding.

Criminal Minds: You might be intrigued to see a murderer in one episode killing his victims by instructing them to kill themselves, which they do obediently after he blows a certain muscle relaxant at their faces. As this Criminal Minds Wiki entry points out, this was exaggerated from urban legends about scopolamine.

CSI: The season 12 episode "Brain Doe" features an MMA fighter who uses dimethyltryptamine, DMT, as a performance-enhancing drug. In real life, it's an extremely powerful hallucinogen. Presumably, the writers read about athletes using the other DMT, the designer steroid desoxymethyltestosterone, and mistook it for the drug...

The sedative he uses on his victims (which also incidentally takes effect immediately) is a real-life tranquilizer, used to sedate elephants. Apparently, getting it on a human's skin can kill them. Maybe he dilutes it?

Carfentanil (tradename Wildnil), a chemical relative of fentanyl, is the most potent opiate. 10,000 times stronger than morphine, it is used for large animals. Yes, a small amount on your skin can kill you.

A bottle of water is returned from the lab, analysed as containing "40% alprazolam" — a higher concentration than an alprazolam tablet, and certainly enough that it wouldn't taste anything like water. A swig of it would be a lethal dose.

Doctor Who usually avoids this by not naming substances or using entirely fictional ones, but "The Mark of the Rani" gets things badly wrong when the Doctor and Peri survive a booby trap claimed to involve mustard gas without ill effects, by wearing minimalist gas masks that only cover their noses and mouths (and look more like medical gas administration masks than anything protective). In reality, the effects of mustard gas on skin and eyes would have killed them. Slowly and horribly.

General Hospital: An 80s story arc had a character get Easy Amnesia from exposure to a chemical that occasionally produces short term memory loss, but far more often results in crippling brain damage from even mild exposure.

Inspector Lynley: This winds up being a plot point in the episode Missing Joseph where Lynley and Havers find it incredibly unlikely that a trained herbalist like Juliet Spence would mistake water hemlock for wild parsnip, which wound up in the meal she made for herself and the local vicar, which killed him but only sickened her since she induced vomiting in herself as soon as she felt ill. For most of the episode they operate under the assumption that someone else slipped it into the food, but turns out it was Juliet all along, and the whole making herself vomit was part of the plan so they wouldn't suspect her. And the vicar? Her own husband, though she had faked her death years before and killed him because he found out that her daughter wasn't actually hers and had in fact been stolen from her real mother.

LOST: In one episode Urley is desperately searching plane wreckage for clonazepam, an anti-anxiety drug, to control his hallucinations. It is unlikely this drug would help. Later, Jack, a medical doctor who should know better, describes clonazepam as an antipsychotic, which it definitely is not.

Merlin: Gaius must be a truly magnificent magician, because he is an absolutely terrible herbalist. Valerian would have very little use for an injury. Fenugreek is an herb used to increase a mother's milk supply, not "heal" someone on the brink of death. The list goes on. The writers must have a big piece of paper hung on a wall with a list of herbs they thought sounded cool and a large supply of darts.

Midsomer Murders: In one episode an old lady took a large amount of pills, wrote a suicide letter, had tea and then confessed to everything to the detectives before oh-so-conveniently dying before she could be arrested.

Revolution: In the pilot, it's highly unlikely that the asthma inhaler Grace uses to treat Danny has a shelf life anywhere near 15 years, especially without temperature controls. Grace does appear to have access to some high technology and a larger conspiracy, so it's possible new medications are being manufactured somewhere.

Even old medicine probably still has some of the active constituent in it, due to the half-life effect. The inhaler was probably still better than nothing. Also, asthma attacks will resolve on their own (assuming you don't suffocate in the meantime); medicine just reduces severity and duration.

Outlander: Claire says monk's hood (aconite) has no known medicinal uses. In reality it has several, well known since ancient times, though since it's highly toxic in larger doses other medications are used now. This might be excused as just ignorance, except she is a trained nurse and highly knowledgeable of herbs so you'd expect she'd know this.

Meta

Addiction has three aspects: habituation, tolerance and withdrawal. Marijuana, for example, doesn't fit the classic model for any of these categories. (Some have referred to a "reverse tolerance" effect, probably due to novice users not knowing they need to inhale and (for a little while holding their breath. Some tolerance occurs, but even daily users find the effects readily obtainable.) Ceasing use of cannabis causes no withdrawal symptoms whatsoever: unless you include minor insomnia among those who use it as a sleep aid (people prone to insomnia before ever using marijuana). Strong habituation—in which people will endure tedious, difficult or risky situations to obtain the drug (similar to with heroin or cocaine)—does happen, but only for a tiny percentage of users: most of whom have problems with impulsive behavior in many areas of their lives. Needless to say, many other "addictive" substances don't meet those three aspects. This is why, even more egregiously, writing someone as being physically and biologically addicted to Frothy Mugs of Water or the G-Rated Drug is, therefore, failing pharmacology forever. Emotional addiction, on the other hand, would be somewhat more believable.

It's been shown that oral consumption of THC doesn't stop smokers from wanting to smoke pot. Thus it is strongly indicated that there are people who, though they might not be nicotine smokers, smoke it habitually, though not necessarily even using it every single day "because of tolerance" (which does exist and is observable in locations such Amsterdam). On withdrawal, the DSM-IV has this as diagnostic criteria: "Characteristic withdrawal symptoms from the substance, such as insomnia or difficulty falling asleep, cravings, restlessness, loss of appetite, difficulty concentrating, sweating, mood swings, raise in temperature, depression, irritability, and anger", which are all clearly noticeable in former heavy cannabis. Furthermore, as (perhaps) the most used illicit drug, cannabis is very easy to abuse in many different kinds of populations.

A number of substances now known not to cause physical dependence can indeed cause horrifying psychological dependence, and in fact, "classic" habituation/tolerance/withdrawal addiction may only be a real thing for depressants and opiates. Most medical publications (including the DSM, which handles drug dependencies, and does list cannabis among them) and addiction counseling agencies do not distinguish between psychological and physical addiction. Although, that itself could be Hollywood Psychology, in that addiction counseling is an industry and there have been some valid critiques of it being too influenced from the law enforcement/Drugs Are Bad perspective and/or engaged in Manufacturing Victims.

The above is further illustrated that while emotional and psychological addiction is real, not even all emotional/psychological addiction necessarily needs to involve drugs at all. In some cases (binge eating disorder, hoarding/shopping addiction, gambling addiction, romance/sex addiction) the "drug" is, in a case of Your Mind Makes It Real, none other than the endogenous neurotransmitters of one's own brain, when a positive emotional experience (anything from gobbling chocolate cake to a big gambling win to an orgasm) produces an excess of those neurotransmitters, and therefore the addict seeks out the experience.

Lack of said neurotransmitters (especially endorphins and/or a proper response to them, or dopamine and a proper response to it), on the other hand, actually can predispose people to addiction to physically addictive substances such as opiates (that physically mimic endorphins as well as well as have an effect on dopamine) or MDMA/amphetamines/methamphetamine (that physically force the release of more active dopamine into the brain). So in effect, if a person's brain is imbalanced in a way that it has higher levels and enjoyable/pleasurable activities can produce the craving for more of them as if they were drugs, the person is more likely vulnerable to emotional addictions (from anything from cannabis to chocolate to having sex irregardless of risk or personal cost of doing so). If, on the other hand, the person's brain is imbalanced to where it does not produce enough dopamine or endorphins to stave off feeling low, they are at more vulnerability to seek out the physically addicting substance that, at least for the short term, provides a high that relieves that low.

Newspaper Comics

In For Better or for Worse, Deanna gets pregnant with her and Michael's first child, Meredith, by accident. She claimed she was switching birth control prescriptions and didn't know that there would be a period of increased fertility between cycling off the old meds and starting the new. Although not everyone knows this side effect, Deanna is a pharmacist and admits she should have realized the risk.

Averted apparently in the d20 games style. It's not a perfect simulation, but the fact that there's an onset time you have to sit out has made some players turn away from poisoned dartguns as a way to convince distant enemies to go to sleep in the modern-set Spy Craft game.

Video Games

Tsukihime, Kohaku uses the dried crushed seeds of Korean morning glories (aka datura) to give several characters hallucinations and make them think they're going insane. So far so good, but it also depicts the effects of the hallucination as giving the victim a sort of hypnotized pseudo-mind control state, where Kohaku can whisper to them something while unconscious and have them believe her.

Judging from the rattling there are only a few pills left in the bottle, making this less likely to just kill the survivor.

To the Moon: Some beta-blockers, especially propanolol, are indeed used to treat post-traumatic stress disorder (although the treatment is still considered experimental), but they usually does not induce amnesia (what they do is more in the line of allowing someone to relive a traumatic memory without experiencing the trauma). There is no way beta-blockers could have completely erased all the memories of Johnny's life with his brother, except maybe as an incredibly rare and unexpected side-effect. And the idea that it could have been done on purpose in a controlled way, as implied in the game, is even more absurd.

In the Director's Cut edition of Scratches, the brief sequel/epilogue reveals that the mother of the game's Madwoman in the Attic had been taking Thalidomide, presumably accounting for her child's deformities. But thalidomide is specifically responsible for phocomelia, a birth defect in which the limbs are underdeveloped and flipper-like. Robin may be grotesque, but he's not a phocomeliac, and wouldn't be very scary if he were.

The weblog Polite Dissent often reports on such misuses in comic books and TV shows, primarily pointing out when the wrong drugs are being used, super heroes blandly hand out DEA Controlled Substances, and where the dosages are ridiculously off. The author of the blog is a comic book fan and a licensed doctor, so the articles can be quite informative. He also does surprisingly comprehensive write-ups of House from the same perspective.

Western Animation

An episode of The Simpsons had Lisa being put on antidepressants and immediately falling into a blissful and oblivious state complete with hallucinations. In real life antidepressants simply get you back to normal; they don't give you instant happiness. And they certainly don't cause visual hallucinations.

While it is not the normal reaction, there is a bit of truth to this one. Anti-Depressants when given to a bipolar individual can make them go into a manic episode. They also can cause mood imbalances when they're first started while the body acclimates, but nothing so extreme.

They also take a while to take effect (sometimes several weeks); it wouldn't be the instant mood lift that Lisa got.

Real Life

No Medication for Me is a huge cause of problems in Real Life, when people invoke it from media depictions, enough to be mentioned on Television Is Trying to Kill Us as one way that doing what you see in the media can literally kill you. Here are a few of the ways that refusing medication/stopping it abruptly or too soon can kill or seriously injure you:

Some illnesses are treatable, not curable. This includes most mental illnesses at the time of this writing, Type 1 (and some cases of Type 2) diabetes, epilepsy, and HIV/AIDS. True, there are some mild to moderate mental illnesses can be compensated for via therapy and life changes, and there are some mental illnesses where medication is actually of limited or no use. That said, if you are bipolar or schizophrenic or severely depressed, please take your medication for your own sake (and for others, especially if homicidal or violent behavior has ever been a part of your illness). If you suffer from diabetes or epilepsy or HIV/AIDS, your medication treatment and adhering to it properly keeps you alive, and so far, nothing else has been found other than said medication treatment that does that. In the case of HIV/AIDS, your medication treatment and adherence to it also reduces your risk of infecting other people. Take your meds, and consider any other treatment supplemental at best.

Some illnesses (specifically bacterial infections of various sorts from pneumonia to gonorrhea to tuberculosis) are highly adaptive, and if any survive a course of antibiotic treatment, the surviving bacteria become resistant to said treatment, then go on to infect you again AND infect other people with something the antibiotic you took now no longer works to kill. This is called antibiotic resistance, and if it advances successfully enough, it is literally an apocalyptic-level threat. You can do your part to prevent it by taking your entire course of antibiotics rather than stopping them to save or throw away the second you feel somewhat well again.

Whatever you may think of vaccination in general, there are some illnesses that it really is the best option in preventing. Even if vaccines did cause autism (they don't), one can live with autism a lot better than one can live with quadriplegic paralysis from polio. The great majority of vaccine reactions aren't the horrific ones - they are things like flulike symptoms for a few days or a temporary fever, which is more than worth it to prevent diphtheria, polio, whooping cough, tetanus, and similar, and while shots do occasionally cause cancers in pets, vaccinating your animals for rabies, feline leukemia virus, and parvovirus at the least will more likely than not save their lives and, in the case of rabies, save human lives. One thing to keep in mind when evaluating whether vaccination is a good idea is "how likely is this illness to kill me or my child or my pet?"

Finally, many medications carry withdrawal syndromes. Opiates and benzodiazipines have withdrawal syndromes bad enough to kill you if they are stopped Cold Turkey rather than tapered or quit in a medical setting, and antidepressants and antipsychotics can induce the same symptoms of the illnesses they are meant to treat, even in healthy people who were taking them for off-label uses (e.g. if you were taking Celexa or Paxil for pain or fatigue, you may find yourself suicidally depressed from suddenly stopping, and if you were taking Risperdal for ADHD or Seroquel for insomnia and pain, you may hallucinate or become psychotic from sudden withdrawal from it - and these are withdrawals from the drugs, not the drawing out of said illness that requires the medication be restarted)

Some statements made in news articles and in anti-recreational drug information. You do not go into a blind killer rage from smoking marijuana (unless it was heavily contaminated with PCP and that's unlikely). LSD does not break your chromosomes and render you infertile (though some of the things now sold as it might cause some nasty side effects.) Scare 'Em Straight becomes laughable at a point.

There's usually a tinykernelof truth in there someplace. A patient who took one dose of MDMA (Ecstasy) was in a coma by morning, and dead that afternoon. Not from the drug itself but from water intoxication. (The drug messes with sodium levels and body heat regulation, and Ecstasy is usually used in raves, where there is plenty of physical exertion, sweating and drinking.) If the ads would explain the real dangers instead of using stupid scare tactics, maybe people would at least be more careful, and survive.

It's a simple Law of Great Numbers. Medicines are thoroughly tested and producers are obliged to indicate any side effects, even there was only one case observed in millions of uses. This is why some seemingly harmless medicines have very severe possible side effects listed. Now scale it up to drugs that lack quality control and are taken in uncontrolled manner with pretty vague dosage.

In Real Life, drugs and poisons take time to take effect. Drugs taken orally, for example, can take anything up to 30 minutes to 2 hours to cross into the blood and take effect. In some works of fiction, they're sometimes shown taking effect instantly or at least more quickly than what they logically should. One such trope is Instant Sedation.

Belief that drugs work instantly is a major cause of real-life overdoses. This is especially common in situations where one wants relief quickly, like constipation or sleeplessness or pain, or where one wants to get high fast. While with some drugs the overdose will only be unpleasant or embarrassing, many of them can kill you. Yes, even over the counter pain medications. ALWAYS check the time to onset before concluding that the first dose didn't work.

An unfortunately common example is paracetamol, also called acetaminophen, Tylenol, and Panadol. If the regular dose doesn't get rid of your headache, do not stack up another dose, lest you suffer irreversible liver damage leading to a very slow and painful death.

Another common mistake is with laxative enemas. If the first one doesn't work and, er, stays where you put it, then the right response is to call a doctor. Use more than one and you will absorb too much phosphate, again leading to a slow and painful death. Water and saline solution with no phosphate have a higher safety margin (and are both less irritating and less dangerous than laxative solutions — it's recommended that if you're using an enema to "cleanse" or for mild constipation, that you dump most or all of the solution out of a packaged enema and replace it with distilled water/safe tap water) but even too much of those can cause electrolyte imbalance or intestinal rupture.

Possibly the worst fictional offender in the Instant Sedation department is depiction of veterinary tranquilizer darts. Even the strongest take time to work, which can leave you with an angry, panicked, and now drug-addled animal running around for several minutes. This is one reason police or keepers will sometimes have to fatally shoot an escaped animal, to keep bystanders safe. (The other reason is that it's actually safer when you miss. If a human gets hit with a gorilla-strength Cap Chur dart, and is not actually standing in a hospital at that moment, he's more surely dead than if he was hit by a shotgun.)

Ignoring route of administration as being important. Route of administration can change effect, can reduce or eliminate safety margins, can lead to some parts of a complex substance being more prominent in effect than others, and can have many other differences. Here are a few common routes of administration to the human body, in descending order of speed/ease of effect, the first three (intravenous, rectal, and intramuscular) all going directly into the bloodstream doing at least a first bypass past the body's own methods of protection from toxic substances - which makes them both more immediately effective and more dangerous (though in some cases less dangerous where the drug/chemical/substance's main toxicity is to the stomach/liver/similar - testosterone, for example, is safer as an intramuscular injection or skin absorption method because its primary toxicity as an outside substance is to the liver, and many chemotherapy drugs are so hepatotoxic and toxic to other systems that they must be administered intravenously to achieve their effect quickly and with as little "collateral damage" as possible):

In fictional depictions (as well as in most pharmaceutical advertising), drugs and chemicals always appear to act as if the human body is a vacuum. In Real Life, there is no such thing as a drug without side effects, some of which can be unpleasant or unwanted, and some of which can be more valued than the drug's main effect (e.g. Viagra was originally developed as a heart medication, but turned out to have more usefulness for increasing blood flow to another part of the anatomy). Drugs and chemicals also have interactions with other drugs and chemicals. Even placebos can have side effects or interactions due to their inert ingredients.

This is why when you are about to start a new drug, it's always a good idea to tell the doctor everything else you're taking. Also ask about food restrictions, vinegar or wine can cause a fatal heart attack if you're taking an MAO inhibitor, and grapefruit juice can render some antivirals and antirejection drugs ineffective.

The concept of "set and setting" is related to the above and also something that many people in Real Life ignore, to their regret, as well as almost never being mentioned in fictional portrayals. "Set" means the mindset in which you consume the substance (e.g. your motivation for taking it and present emotions, e.g. someone Drowning My Sorrows and someone having a celebratory drink may have very different reactions to the alcohol, even if they are the same person), while "setting" is the surroundings in which the substance is consumed (e.g. are you drinking that can of beer in your car behind the wheel, in a loud sports bar, or quietly at home? All may have very different effects on yourself and those around you.) Ignoring set and setting in the use of a substance causes substance use-related deaths and injuries, bad experiences with side effects or original effects, and other problems. "Set and setting" is important in how ANY substance taken will affect you and its effect on others around you as well, although it is probably most important for drugs that more perceptibly alter your perceptions of reality (i.e. "hallucinogens": psychedelics, dissociatives, and deliriants).

Another Real Life problem is the belief that ease of access equals safety.

Acetaminophen/Paracetemol/Tylenol is one of the easiest pain killers to buy over the counter. An overdose will kill you even more surely, and far more painfully, than an overdose of any opiate. A fatal dose of morphine is easy to spot, and a hospital can counteract it with breathing support and an antidote. An acetaminophen overdose is harder to spot, and unless it's caught very early, the only treatment is a liver transplant.

A common discussion point in drug regulatory affairs classes is the fact that Acetaminophen would have never been granted FDA approval—much less OTC approval—if introduced today. Acetaminophen overdose is still the most common reason for drug-related hospitalizations in the US.

One of the most unfortunate issues with acetaminophen is its inclusion in opiate painkillers, most notably Vicodin and Norco and Tylenol 3 and the like, where it is combined with hydrocodone. This was initially done solely to allegedly stop opiate abuse - unfortunately, it didn't do a thing to stop opiate abuse, in that hardcore opiate users found a way to remove the acetaminophen prior to injecting the contents of the pills, while less-hardcore opiate users who took too many of the pills suffered unnecessary liver damage - as did and do people taking them legitimately for pain. Worse yet, repeated studies have proven that the acetaminophen adds nothing to the pain relief in such mixes - meaning it does zero good and a lot of harm. Even more tragically, the introduction of codeine-only/hydrocodone-only painkillers (which would spare opiate addicts and legitimate users alike from the danger of liver damage) has actually been treated as a moral panic issue, with fears raised that it will increase painkiller abuse - rather than reduce harm to people already doing it.

DXM/Dextromethorphan, an over the counter cough remedy that even kids can buy in most states, is one of the most risky legal highs around. Mix the effect with anything from antidepressants to MDMA to certain foods, and you can quite easily die from serotonin syndrome.

Another problem with DXM is that many users are uneducated teenagers, which leads to many of the issues with it. DXM is arguably a safe enough drug (provided you aren't using anything that causes the interactions) but its safety is heavily dose-dependent. At the "first plateau" it's no more dangerous than having a few too many drinks (as in, driving is a no-no, but effects are generally enjoyable and once it wears off no harm done as long as you don't repeat it every day), but once you get into the third and fourth "plateaus" with higher doses the risks of poisoning and loss of bodily and mental control are far higher. The problem is that many of the uneducated users don't know what proper plateau dosages are, so instead of an experience that is akin to four beers and a Ritalin/a "dirty" stoned feeling, the experience is akin to ketamine or hallucinogens. Hitting the third or fourth plateau by accident, when unprepared, is often a guarantee of at least a bad experience. Worse, some people have an enzyme deficiency or are heavy tobacco smokers and nicotine metabolizes the same way - making a first plateau dose a third.

DXM is also ineffective as a cough remedy unless you reach first plateau (the dissociation is what controls the cough), as many people taking it legitimately have found out. Below "high" level, it is a mere placebo and honey or cough drops work better.

Diphenhydramine (Benedryl) is an anticholinergic drug which, at normal doses, alleviates allergy symptoms and insomnia. In large doses, it's a potent deliriant which can cause total short-term memory loss as well as extremely vivid hallucinations. The most common hallucinations? Spiders and shadow-people.

The earlier-mentioned datura/Angel's Trumpet/jimsonweed may be the king of this trope. It naturally grows in many locations, and a small dose causes realistic hallucinations and delusions (e.g. you forget that you're on the drug, unlike psilocybin shrooms or similar where you're hallucinating but you know or can be reminded that you're high) that would otherwise be seen only in paranoid schizophrenia or heavy PCP use. Or that same small dose might just kill you instead, because it's also incredibly poisonous. Worse yet, one of its effects is lack of awareness of the high/the hallucinations until you're well in the danger zone, so you may consume an overdose thinking it's had no effect. No matter that it's easy to get, it is at least as dangerous as crystal meth, heroin, or any other drug you can think of, and all of the illegal hallucinogens from psilocybin to LSD are far safer. In many places it's argued that anyone who tries to get high on jimsonweed might as well be the poster child for Utter Failure At Pharmacology. There's a very good reason why datura has the most negative experience reports on Erowid (even crystal meth is above it) and why the datura vault is a case of Accentuate the Negative: because it gives terrifying and often physically dangerous trips, makes you play Russian roulette every time you take it, and has a lengthy comedown that ranges from "nasty" to "debilitating". In short, anyone who trips on it is Too Dumb to Live.

This extends to nearly all plants containing tropane alkaloids. It is usually legal to possess or grow them. And they are extremely dangerous (active dose close to lethal dose, poisoning often involves cardiac arrest and other CV failures). Many psychedelic fungi (especially of Amanita family) also qualify. The safest psychedelic fungi, in a case of irony, is the one that's deemed illegal in many places, as is the safest method of growing it (indoors, in a monoculture that cannot be invaded by dangerously poisonous fungi).

Tobacco. In most countries, it can be bought over the counter (or even from a vending machine) by anyone deemed old enough by law, and if you're not old enough, accessed easily enough through friends/family/co-workers/whatever that are. It's also almost as/more addictive than heroin and one of the most physically destructive drugs over long-term use.

It also does not help that the most popularly sold/easily available forms of nicotine/tobacco consumption are the most dangerous forms, smoking and chewing tobacco/snuff. Nicotine is an example of "the dose makes the poison" (e.g. pure at lethal dose it is a deadly poison, but well below lethal dose it is an addictive stimulant much like caffeine), and the cancer risks are due to other components of tobacco smoke or the way the tobacco is cured. While nicotine lozenges and vaporization, for example, are still addictive and have heart risks for some, both are far safer options regarding cancer risk and lung involvement than smoking or chewing tobacco.

Ditto for alcohol. Not only quite addictive and dangerous when used on a regular basis or overdosed but also heavily interacting with many prescription drugs sometimes heavily decreasing their toxicity threshold (especially the acetaminophen mentioned above).

The belief, propagated by a few old mystery stories, that finely powdered glass was an undetectable poison to slowly shred the victim's insides. If it were finely powdered enough not to be painful in the mouth, it would do no damage further down the line.

Homeopathy: Premise no.1: The law of similarity. "Let like be cured by like." Ex: "Water with 'memory' (see below) of arsenic will cure anything with symptoms similar to arsenic poisoning." Premise no.2: Succussion. Apparently, banging weakly adulterated water against a wall will turn it into a weak elixir, banging water weakly adulterated with that will make a stronger elixir, and so on until, if you weren't pouring out most of the water, you'd have used, by 25C, the mass of the observable universe per hundred micrograms of toxin. And then you keep going.

The common explanation homeopaths give for their remedy is that, in one way or another, "water has a memory". At the time homeopathy was first being developed, atomic theory wasn't as well-established, so some people figured that no matter how much you diluted something, there'd still be something there. In this view, water isn't made of separate non-liquid molecules but out of water, at all levels of abstraction, and therefore you can never remove all the solute from a solvent. Since we know better now, a new account about "water memory" (often coupled with "quantum" something) had to be developed. The new explanation is that "String theory says that all mass is strings, and all mass can be the size of a bowling ball, so allmasshas thesame mass asa bowling ball". Yes, it's based on assumptions that String Theory is true, as well as a complete and utter unknowing of the difference between mass and volume. A better explanation (minus the sardonic Potholing) here.

It's worth noting that at the time homeopathy was first proposed, many "medicines" included things like arsenic or mercury - so diluting them down to nothing actually did improve patient outcomes by virtue of "not poisoning people".note Although in some cases, arsenic and mercury were effective—if dangerous—treatments; arsenic was particularly effective for syphilis, and the first "modern" medicine was an organoarsenic compound for syphilis treatment. Nowadays, not so much.

Some people think that the iron and other metals found in cereal, vegetables, meat and other foods is somehow different than the iron used to build cars and skyscrapers. Iron is iron- the same stuff they pour into blast furnaces is the same stuff in your bowl of Wheaties, in your steak, and in your blood... just in very, very, very small amounts.

The iron in your Wheaties is probably not in the form of elemental iron, but is in some oxidized form, possibly an acid salt, like ferric citrate, or some iron oxide.note Which, by the way, is rust.

Corresponding to this, there are people who think that a certain amount of a vitamin or mineral is good, so more is better. Everything is poisonous in sufficient quantities and some vitamins (especially A and D, with the added "bonus" that they're toxic in high concentrations) and minerals remain inside the body, so people taking megadoses of supplements may be slowly poisoning themselves, all the more tragic for the fact that megadoses are consistently shown to have no proven health benefit outside of extreme cases. B6, while it doesn't accumulate as much as A or D, is another vitamin toxic in megadoses - too much causes nerve damage and Parkinson's like symptoms.

Contrary to what one might see in many espionage movies, potassium cyanide does not kill in matter of seconds. It takes at least few minutes before cyanide begins to act, and few following minutes to cause death by massive apnea and cardiac failure. Additionally, victims are also portrayed as frothing at mouth and quickly passing out. In reality, an acute cyanide poisoning is pretty messy affair involving strong seizures.

For this exact reason, the preferred suicide method for Those Wacky Nazis was biting a glass vial of cyanide and immediately shooting oneself in the head. Eva Braun did not shoot herself (apparently because she wanted to leave a good-looking corpse), but seems not to have suffered strong seizures (from the testimony of those outside the room where she did it) - some speculate that Hitler may have held her through the process, then bitten his capsule and shot himself after. When Heinrich Himmler had to bite his capsule without a pistol, he suffered a long and painful death, though this may have had something to do with his desperate British captors scraping whitewash from the walls and forcing him to eat it in a futile effort to make him puke the poison back up.

The idea that different types of alcohol have different effects/are "less dangerous." While there is some slight truth to the idea in regard to three points:

Beer, wine, cider, and other fermented alcoholic drinks usually have a higher liquid to alcohol volume than distilled spirits such as vodka or whiskey;

Wine has shown some positive health effects in moderate amounts that beer and distilled spirits have not;

And some beverages contain more congeners and sulfites than others, causing worse hangovers/severe allergic reactions in those sensitive to congeners, sulfites, or both,

it is important to remember that:

A shot of whiskey and a glass of wine have exactly the same amount of alcohol.

Overconsuming any type of alcohol will make you drunk and chronically overconsuming it will endanger your health just the same whether it's wine, beer, whiskey, or whatever.

There is NO alcohol that is "safer to consume" before driving. If you've consumed more than one standard drink (or if you've consumed one multiple serving drink such as a Long Island Iced Tea or a zombie or a double or triple) you are a Drunk Driver if you get behind the wheel within four to six hours (at least for two to three drinks - even longer if you've drank more). The standard rule is that it takes the body one to two hours to process one serving of alcohol to the point where one is "sober" from that one serving.

Alcoholism can exist even if one avoids specific types of alcohol more notoriously connected to it. The person drinking several full glasses of fine, high-value wine a day is just as much of an alcohol abuser or alcoholic as is the one drinking a bottle of whiskey a day, and vice versa.

One side effect of the increasing availability of Narcan/Naloxone is that due to its almost Reality Is Unrealistic levels of effectiveness (to the point that it can take effect in seconds depending on how much drugs were in the victim's systems at the time of administration) people assume it "cancels out" the opiate and will do things like affect a drug test's results and give a negative result for opiates. The reality is the original opiate stays in the system like normal, all the Narcan does is attach to the brain's receptors to keep it from having a physiological effect and the original dose that caused the overdose is still there. Additionally Narcan's half-life means that it will likely wear off well before the opiate does and the person can overdose again from what's already in their system and die this time, which is why EMS is not allowed to release a person even after giving them Narcan and must transport them to a hospital for continued treatment. This is one reason some medical professionals are opposed to increasing its availability over the counter as it's feared that people will misunderstand what it actually does and feel free to continue taking more drugs and irreversibly overdose.

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